Malta has a very long and distinguished history of healthcare delivery, spanning several centuries. Suffice it to mention the repute of the Maltese hospital set up by the Hospitallers Order of the Knights of St John, on to the “nurse of the Mediterranean” fame during World War I and the present day-to-day success stories registered by our hospitals.
Notwithstanding our successes, the Maltese health system, like all other advanced health systems, faces significant challenges in the form of our ageing population, the growing burden of obesity and other chronic diseases and environmental changes and the ever-increasing cost of sustaining a quality and expanding medical service.
The vast majority of patients using the Maltese health services have a positive and satisfying experience. The services we provide are comprehensive and up-to-date. Our specialists, doctors, nurses and allied health workers give an overall excellent service with pride and dedication.
Can we do better? If we can, where and in which disciplines? How do we compare with health systems in neighbouring countries?
If we are to provide the best we can in healthcare we need to answer these and related questions.
With this in mind, action has been taken to start to regularly and consistently monitor and assess our performance through the introduction of a health system performance assessment (HSPA).
To achieve continuous improvement in our national health system and to ensure access to quality health services and economic sustainability, the health system needs to have an effective and sustainable monitoring and review system.
This is the first time that Malta would have a formal model for performance measurement at a national level.
An HSPA is a performance assessment tool that can be used to map performance information back to the health system’s objectives, functions and processes and thus be used to assess and evaluate the performance of the Maltese health system.
This is essential in today’s environment of transparency and accountability. My secretariat has nominated a working group to develop and implement Malta’s first HSPA.
The working group has been carefully drawing up and shortlisting indicators that collectively cover the health systems in Malta as comprehensively as possible. To do this, its members also reflected on the experience of other countries that have been carrying out such HSPAs.
Special thanks are due to Juan Tello, programme manager responsible for health governance at WHO Europe’s Division of Health Systems and Public Health, for his energetic support for the set-up of the HSPA and for facilitating support from experts who had been responsible for setting up such a system in their own countries.
The health system needs to have effective and sustainable monitoring and review
Among the criteria used in the selection of indicators, preference was given to those available in the international health databases, particularly the ones to which Malta already contributes.
Apart from allowing benchmarking, such an effort would allow the HSPA to be repeated with minimum additional effort, making the exercise sustainable and easier to maintain.
The group’s work is now drawing to a close and the first report is due to be published in the coming weeks.
Through measurement of numerous performance indicators, it will take into account and assess various facets of Malta’s health service, including its efficiency and effectiveness, its level of quality and accessibility to timely and adequate healthcare, its financial status and affordability, user experience and patient satisfaction as well as health status indicators such as life expectancy, mortality, risk factors, premature mortality and cancer survival rates.
This comprehensive overview will provide a snapshot of how we are performing today and allow us to focus on those areas that require further improvement.
Indicators can be compared to adequate benchmarks where these are available or, eventually, to previous editions of the Maltese HSPA once this exercise is in place and repeated every few years, identifying any gaps requiring further investigation and action or investment.
No doubt, we will uncover areas which need improving.
This is the principle aim of the whole exercise: to identify not only where we are achieving but also where we can do better.
Only by doing this can we then make sure we are providing the best.
As a clinician, I am used to taking decisions based on evidence and good practice.
The same should apply to decisions I take as a politician where policies and plans that affect the whole population should be driven by evidence and proper information.
The HSPA will provide such evidence and will allow the government to continue ensuring a transparent and accountable health system is in place for the benefit for all its users.
The ministry is determined to increase the accountability of the Maltese health system by creating a framework wherein monitoring and evaluation of its performance is part of the way we govern this country.
Chris Fearne is Parliamentary Secretary for Health.